A case report of ultrasonographic findings in bilateral diffuse Uveal melanocytic proliferation.

BACKGROUND: To report undescribed characteristics of patients with bilateral diffuse uveal melanocytic proliferation (BDUMP) on ultrasound biomicroscopy (UBM) and high-frequency B-scan ultrasonography. CASE PRESENTATION: Two of four participants presented with worsening bilateral vision after previously diagnosed primary pulmonary or ovarian carcinoma. The other two patients were diagnosed with lung carcinoma after presentation with BDUMP. All patients had ciliary body nevi-like lesion in combination with iris or ciliary body cysts, and uveal thickening on UBM. Focally elevated choroidal nevi-like lesion and exudative retinal detachment with choroidal thickening were detected with B-scan ultrasonography. CONCLUSIONS: Our case series demonstrates the uveal characteristics of patients with BDUMP based on high-frequency B-scan ultrasonography and UBM. Ultrasonographic findings are crucial in the diagnosis of BDUMP because it is occult in nature.

Transient Myopia Secondary to Supraciliary Effusion: Unusual Complication After an Uneventful Prolene Gonioscopy-assisted Transluminal Trabeculotomy.

PURPOSE: The purpose of this study was to report 2 cases experiencing a transient decrease in their vision due to the development of acute myopia after an uneventful prolene gonioscopy-assisted transluminal trabeculotomy (GATT) surgery. METHODS: A 52-year-old woman with primary open-angle glaucoma and an 8-year-old boy with juvenile glaucoma underwent uneventful GATT surgery. RESULTS: On the postoperative first day, both patients had mild shallow anterior chamber and intraocular pressures measured as 19 and 16 mm Hg, respectively. Both patients had myopia measured as -4.5 and -6.0 D, respectively. Fundus examination was unremarkable in the first patient, whereas it showed bilateral optic disc cupping and retinal nerve fiber layer atrophy in the second patient. In the first patient, supraciliary effusion was detected by using ultrasound biomicroscopy. Ultrasound biomicroscopy could not be performed in the second patient, but ocular ultrasonography revealed a thin layer of suprachoroidal fluid. Myopia was completely regressed, and visual acuity increased within 1 week of the follow-up in both patients. At the sixth month of the follow-up, intraocular pressures in both patients were under control without any antiglaucoma medications. CONCLUSION: Transient decrease in vision after the GATT surgery might occur secondary to supraciliary effusion leading to acute, transient myopia.

Ciliary Body Mass as a Feature of Ocular Sarcoidosis.

Importance: Ocular sarcoidosis may be the primary and only clinical manifestation of sarcoidosis, and irreversible loss of visual acuity may occur from delayed treatment. Thus, early diagnosis is imperative to preserve visual acuity. Establishing the diagnosis of sarcoidosis in cases manifesting only in the eye may require a diagnostic biopsy, which may prove challenging in the absence of available ocular surface, lacrimal gland, and systemic tissue for biopsy. Objective: To describe diffuse or segmental ciliary body mass as a clinical sign and tissue source for biopsy in the diagnosis of ocular sarcoidosis. Design, Setting, and Participants: This case series captures 3 cases from a university-based ocular oncology and uveitis practice. All 3 patients presented with uveitis and a diffuse or segmental ciliary body mass, which was identified via ultrasonographic biomicroscopy. Main Outcomes and Measures: Clinical, ancillary, and histopathological ocular findings in the 3 patients. Results: The patients were a 52-year-old white woman, a 42-year-old African American man, and an 81-year-old white man. Two individuals had unilateral involvement, and 1 had bilateral involvement. All 3 individuals presented with uveitis. Diffuse, circumferential ciliary body masses were observed in 2 patients. A localized, nodular ciliary body mass on the temporal quadrant with superior and inferior extensions was observed in 1 patient. Moderate to high internal reflectivity was observed on ultrasonographic biomicroscopy in all 3 individuals. Biopsies of the ciliary body masses were diagnosed as sarcoidosis in all 3 patients. Conclusions and Relevance: These findings support that diffuse or segmental ciliary body mass may serve as a clinical sign and tissue source for biopsy in the diagnosis of ocular sarcoidosis, although the frequency of this cannot be determined from 3 cases. To our knowledge, such cases all demonstrate a uveitic component; whether a ciliary body mass caused by sarcoidosis can occur in the absence of uveitis remains unknown.

Characterisation of choroidal morphological and vascular features in diabetes and diabetic retinopathy.

AIM: We aimed to characterise specific morphological and vascular features of the choroid in Indian adults with diabetes and diabetic retinopathy (DR). METHODS: Consecutive participants from the Singapore Indian Eye Study's 6-year follow-up examination underwent choroidal imaging using spectral domain optical coherence tomography (OCT) with enhanced depth imaging. Raw OCT images were loaded on a custom-written application on MATLAB that enabled delineation for detailed morphological and vascular analyses. Multiple linear regression analyses were performed to assess differences in choroidal characteristics by diabetes DR. RESULTS: Of the 462 recruited participants, 273 had no diabetes (mean age was 60.1±6.8 years), 100 had diabetes but no DR (61.8±7.4 years) and 89 had DR (62.4±6.0 years). In multiple regression analysis, after accounting for relevant confounders, compared with those without diabetes, participants with diabetes had significantly thinner mean choroidal thickness (CT; mean difference (MD)=-25.19 µm, p=0.001), smaller choroidal volume (MD=-0.23 mm3, p=0.003), more inflection points (MD=1.78, p<0.001) and lesser choroidal vascular area within the foveal (MD=-0.024 mm2, p=0.001) and macular (MD=-0.095 mm2, p<0.001) regions. Among the diabetic group, subjects with DR had significantly thicker mean CT (MD=25.91 µm, p=0.001), greater choroidal volume (MD=0.24 mm3, p=0.009), lesser inflection points (MD=-0.478, p=0.045) and greater choroidal vascular area at foveal (MD=0.016 mm2, p=0.019) and macular (MD=0.057 mm2, p=0.016) regions, compared with those without DR. CONCLUSIONS: Choroidal morphology and vasculature were altered in Indian adults with diabetes and DR. These findings may provide insights into choroidal changes in diabetes and DR.

Case report: imaging and treatment of ophthalmic manifestations in oculodentodigital dysplasia.

BACKGROUND: Diagnostic and surgical management of severe chronic angle- closure glaucoma secondary to ciliary body cysts can be difficult to manage in a patient with oculodentodigital dysplasia. CASE PRESENTATION: A 6-year old girl with oculodentodigital dysplasia, with progressive chronic angle- closure glaucoma secondary to ciliary body cysts presented to our clinic. The initial examination revealed counting fingers vision in the left eye. Intraocular pressure (IOP), as assessed by tonopen, was 31 mm Hg. Ultrasound biomicroscopy revealed ciliary body cysts in the left eye, and gonioscopy confirmed chronic angle closure. A tube shunt was placed to control the elevated IOP. A year after her tube shunt placement in the left eye, ultrasound biomiscropy was performed on her right eye and showed no ciliary body cysts. Gonioscopy in the right eye revealed an open angle to the ciliary body band. Subsequent serial gonioscopy every 3 months showed gradual narrowing of the right eye angle and finally three-and-a-half years after tube placement of the left eye, her right eye IOP became uncontrolled with medications alone and a tube shunt was similarly placed in the right eye. Intraoperative ultrasound biomicroscopy performed at the time of the right eye tube shunt revealed extensive ciliary body cysts in the right eye. Her IOP in both eyes have been well controlled since the placement of tube shunts. CONCLUSIONS: This is one of the first reported cases of severe chronic angle- closure glaucoma secondary to ciliary body cysts in a patient with oculodentodigital dysplasia. We believe that early screening for ciliary body cysts is important in patients with oculodentodigital dysplasia.

Plateau Iris in Primary Angle Closure Glaucoma: An Ultrasound Biomicroscopy Study.

PURPOSE: To determine prevalence and anterior segment morphology of plateau iris in patients with primary angle closure glaucoma (PACG) after laser peripheral iridotomy using ultrasound biomicroscopy (UBM). METHODS: In this prospective study, 262 PACG patients and 144 normal controls underwent UBM examination. Plateau iris in a quadrant was defined by the presence of anteriorly directed ciliary process, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact in the same quadrant. At least 2 quadrants had to fulfill these UBM criteria. RESULTS: UBM analysis showed plateau iris in 83/262 (31.68%, 95% confidence interval: 26.7%-37.9%) PACG eyes, it was common in female individuals (61.44%), and patients were significantly younger than PACG patients (P=0.006). Plateau iris was found in superior quadrant in 19/83 (22.89%) eyes, inferior quadrant in 19/83 (22.89%) eyes, nasal quadrant in 21/83 (25.3%) eyes, and temporal quadrant in 24/83 (28.91%) eyes. In plateau iris patients, the central anterior chamber depth was shallower, the anterior chamber angle, the scleral-iris angle, and the sclera-ciliary process angle were significantly narrower, and the trabecular ciliary process distance and the iris ciliary process distance were significantly shorter in patients than in PACG subjects. CONCLUSIONS: Patients with plateau iris had significantly shallow central ACD when compared with those with pupillary block and normal eyes. After laser peripheral iridotomy, about a third of PACG eyes had plateau iris. This is clinically important because these patients can develop synechial angle closure and should be followed up closely.

Vitreous hemorrhage secondary to iridociliary cyst.

CASE REPORT: An 18-year-old man, presented a lower vitreous hemorrhage of unknown cause. Multiple tests are performed, including Ophthalmic Ultrasound and Fluorescein Angioghaphy (FA), they did not find justification of bleeding. Finally, we decide to do a Biomocroscopía Ultrasonic (UBM) showing an iridociliary cyst. DISCUSSION: The iridociliary cysts are single or multiple, primary or secondary. The primaries are usually benign so, they do not require treatment. When the cyst has a considerable size, it may produce a focal plateau iris with or without angle-closure. Our case reveals an unusual complication that should take notice of when you have an unknown vitreous hemorrhage.

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts.

OBJECTIVE: To compare ultrasound biomicroscopy (UBM) with standard ocular ultrasonography for detection of canine uveal cysts and to determine the sensitivity, specificity, and interobserver agreement for detection of uveal cysts with UBM. SAMPLE: 202 enucleated eyes from 101 dogs. PROCEDURES: 2 examiners examined 202 eyes by means of UBM (50 MHz) to identify uveal cysts. A board-certified radiologist then examined 98 of the 202 eyes by means of standard ocular ultrasonography (7- to 12-MHz linear transducer). Subsequently, 1 examiner dissected all 202 eyes under magnification from an operating microscope to definitively identify uveal cysts. Each examiner was masked to other examiners' findings. Sensitivity, specificity, and interobserver agreement were calculated for detection of cysts by UBM. RESULTS: Cysts were detected by use of UBM in 55 of 202 (27%) eyes by one examiner and 29 of 202 (14%) eyes by the other. No cysts were detected in the 98 eyes examined with standard ocular ultrasonography. Dissection results revealed that cysts were present in 64 of 202 (32%) eyes, including 29 of 98 (30%) eyes examined by standard ocular ultrasonography. Mean sensitivity of UBM for cyst detection was 47%; mean specificity was 92%. Uveal cysts not identified with UBM were often small (mean diameter, 490 üm). Interobserver agreement was high (κP = 0.81). CONCLUSIONS AND CLINICAL RELEVANCE: UBM was more effective than standard ocular ultrasonography for detection of uveal cysts in enucleated eyes. Small-diameter cysts were difficult to visualize even with UBM.

Ultrasound Biomicroscopic Evaluation of Uveal Effusion in Acute Primary Angle Closure.

PURPOSE: The aim of this study was to determine the prevalence of uveal effusion in acute primary angle closure (APAC), chronic primary angle-closure glaucoma (PACG), and primary open-angle glaucoma (POAG). METHODS: A total of 152 consecutive patients (287 eyes) with APAC, PACG, and POAG were enrolled in this prospective and observational case series study. Intraocular pressure-lowering medications were used and ultrasound biomicroscopy examination was undertaken to determine the presence of uveal effusion and measure anterior chamber parameters. RESULTS: Overall, uveal effusion was evident in 40 of 194 affected eyes (20.6%) and no uveal effusion was seen in their fellow eyes. The prevalence of uveal effusion in APAC, chronic PACG, and POAG was 29.3%, 10.9%, and 3.1%, respectively (χ=226.63, P<0.001). APAC eyes had the highest prevalence of effusion and no effusion in their fellow eyes. In 40 eyes with uveal effusion, grade 1 effusion was seen in 17 eyes (42.5%), grade 2 in 15 eyes (37.5%), and grade 3 in 8 eyes (20%). In APAC eyes, the difference in the mean anterior chamber depth (ACD) among effusion grades 3, 2, and 1 was significant (F=5.425, P=0.017), and the eyes with grade 3 effusion had shallower ACD compared with grade 1 (P=0.031), but the difference was not significant compared with grade 2 (P=0.368). CONCLUSIONS: The eyes with APAC are associated with a higher prevalence of uveal effusion compared with PACG and POAG and probably as a result of rapid reduction in intraocular pressure with aggressive hypotensive therapy and inflammatory response to the process of acute attack.